Urology, Nephrology and Andrology International

Introduction:Urothelial carcinoma is the fourth most common solid malignancy1 in the world. The majority (90– 95%) of cases occur in the lower urinary tract (urinary bladder and urethra) and the rest in the upper urinary tract (renal calyces, renal pelvis, and ureter).2 The management of Upper urothelial malignancy is nephroureterectomy with bladder cuff excision. This Case seriesreviewed the patients treated in a tertiary care and analyzed systematically regarding management. Case series: Upperurothelial tract carcinoma (UUTC) admitted and operated at government Royapettah hospital, Chennai, Tamilnadu for the past 4 years were taken and reviewed. There were 4 cases were operated in our hospital. Average age at diagnosis was 50.6 yrs. All four patients were males. All patients were evaluated by contrast enhanced CT scan. Cystoscopy done routinely for all cases and found no synchronous bladder cancer. All patients underwent laparoscopic assisted nephroureterectomy with open resection of distal ureter with bladder cuff margin. Among these one patient had microscopic margin positive at bladder cuff and treated with radiation. Discussion: Renal pelvis UTUCs are twice as common as those found in the ureter.4 In terms of staging, 60% of UTUCs are invasive (≥pT2) at diagnosis in contrast to the 15–25% for bladder cancers.5 About 7% of patients present with metastatic disease.6 Regarding imaging CT urogram has become the standard of care. The gold standard of treatment for patients with upper tract urothelial neoplasms and a normal contralateral kidney is complete nephroureterectomy with removal of a cuff of urinary bladder. A retroperitoneal lymph node dissection along the ipsilateral great is performed for more complete surgical staging, especially for higher grade and invasive cancers. A lymphadenectomy may not be necessary in cases of UTUC which are low stage and low grade. In our case series, Average operating time was 142 min. Average blood loss was 240 ml. All patients had decreased analgesia frequency (mean 2.1 days), faster return to ambulation (mean 1.5 days), with mean hospital stay of 8 days. In our institute we resected the distal ureter with bladder cuff excision by open technique. Conclusion: In summary, laparoscopic nephroureterectomy with open bladder cuff excision was a safe and acceptable alternative to open nephroureterectomy with bladder cuff excision. Cancer control rates seem to be similar with superior convalescence, but need follow up and large no of cases to mention about recurrence. In terms of managing the distal ureter and bladder cuff, the open technique is the most efficacious in terms of achieving negative margins and decreased risk of cancer seeding.

Keywords: Upper urothelial tract carcinoma; Nephroureterectomy with bladder cuff removal.

Foreign bodies of the urethra and bladder has a low incidence. Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. This case warrants discussion given the great management challenge faced by the oddity and infrequency with which a left out suprapubic cystostomy cannula tip is encountered in the penile urethra. On cystoscopy in a 54 yr patient with acute urinary retention (AUR) and suprapubic catheter (SPC) in situ, the sharp pointed detached cannula tip was found in the urethra. The object was removed endoscopically under local anaesthesia using some special techniques. Introduction: Foreign bodies of the urethra and bladder are seldom seen in clinical urologic practice with iatrogenic injury, self-insertion, and rarely migration from adjacent sites.1 Foreign bodies are most commonly inserted into the urinary tract by psychiatric, intoxicated, confused, or sexually curious patients. Treatment is focused on foreign body extraction, diagnosing complications, and avoiding compromise of erectile function. With advances in endourology, the majority of cases can now be managed endoscopically.2 Here is a description of a very rare case of SPC cannula tip at urethra which was incidentally found during cystoscopic examination and subsequently removed endoscopically.

Keywords: Suprapubic; Systostomy; Catheter.

End stage renal disease (ESRD) has been a long-standing challenge for the community. Renal transplantation being the mainstay treatment reaches only about 5% of the patients due to supply demand mismatch. Open donor nephrectomy (ODN) is the common method of renal allograft harvest. Since it is associated with significant morbidity, the less invasive laparoscopic donor nephrectomy (LDN) is gaining importance. Objectives: This study attempts to compare a group of donors undergoing LDN to those undergoing ODN in terms of factors like operating time, blood loss, conversion rates, hospital stay, complications, post-operative donor renal function along with assessment of graft function. Methods: A prospective non randomized study was conducted on 58 live donors who consented to donate kidney for renal transplantation at Meenakshi Mission Hospital and Research Centre, India. They were compared for intra-operative variables, postoperative complications, post-operative donor function and recipient renal function thereby assessing the graft function. The donors and recipients were followed for a period of 1 year to assess their renal function, occurrence of any new co-morbid conditions, recipients’ graft function. Continuous variables were analyzed using Student’s t-test while categorical variables were compared using the chi square test. ‘a’ value was set at 0.05. Results: Of the 58 patients, LDN was done in 28 patients with two undergoing conversion. The mean operation duration and warm ischemia time for LDN and ODN groups were similar. The length of hospital stay was significantly shorter in LDN group. There were no major complications nor was there any significant differences in the post-operative donor/recipient renal function as well. Conclusion: LDN can evidently be performed with less morbidity, better donor satisfaction and equivalent initial graft function.

Keywords: Open donor nephrectomy; Laparoscopic donor nephrectomy; Kidney transplantation; End stage renal disease; Donor outcome transplantation; End stage renal disease; Donor outcome.